In recent years medicine has made enormous strides in the treatment of high blood pressure. Attitudes and approaches have changed. In the past doctors tended to play down the potential dangers. Because there were no overt symptoms in the earlier stages, fatal strokes or heart attacks were considered accidents of fate rather than the consequences of persistent hypertension.-At the same time they were fatalistic because there was no effective treatment for the disease and its attendant problems until the early '60s.

Today we know that in untreated hypertension life expectancy is inversely proportional to the level of blood pressure. But we also have drugs that will control almost every type of hypertension and bring the pressure down to safe levels. This in most cases means a substantial increase in life expectancy and an improvement in the quality of life.

Figures that speak for themselves

Having read the foregoing chapters you know that treatment is of vital importance. But perhaps you are one of those skeptics who need proof, who want the hard facts on which we base our optimistic prognosis.

Stroke. In the past at least 20%, and according to some statistics, as many as 30-35% of all hypertensives had fatal strokes. Today the incidence is no higher than among persons with normal blood pressure.

Congestive heart failure. Before the discovery of effective treatment almost 75% of all persons who died of congestive heart failure (CHF) had high blood pressure. The average life expectancy after the onset of CHF was 2 to 5 years. Today death from CHF is rare in treated cases of hypertension.

Heart attack. At first glance the statistics here do not look quite so good. The incidence of heart attacks apparently has remained the same. Why has treatment not been effective? Or is it possible that hypertension is not a risk factor in heart attacks?

The answer is not all that simple and the total picture is somewhat more favorable than would seem at first glance. What the statistics fail to show is that persons who are treated for hypertension live longer then they did when fatal complications were more common; without treatment they might well have died of a heart attack at the age of 49 instead of at age 69. In other words the statistics do not take the greater life expectancy into account. Moreover, people with high blood pressure are likely to have other coronary risk factors. So if they have a heart attack even though their pressure has been normalized one will have to ask whether they perhaps suffer from hypercholesterolemia, smoke cigarettes, are diabetic—any one or a combination of all of these may be responsible. It is the conviction of all epidemiologists and clinicians that the heart attack incidence among hypertensives will decrease substantially with the early detection and treatment of any and all risk factors.